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weight loss drugs

Should insurers cover weight loss drugs?

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weight loss drugs“You’re fat”, “don’t eat so much”, “you’re eating the wrong things”… if you are overweight then you have probably heard any number of comments like this thrown in your direction. The fact is, it’s unhelpful and normally untrue. People who suffer from obesity are not just slightly over-weight from bad eating habits, the majority of obesity suffers suffer from underlying conditions that force above average weight gain. Regardless of the reason, people who are severely overweight should be helped and encouraged to lose weight. Preventing excessive weight gain or taking medication to reduce weight would help the person in question but it would also help the healthcare system.

How? Well, for starters it’s much cheaper to treat obesity with weight loss drugs than it is to treat the consequences of obesity. Obesity normally results in many other health complications. Reducing the obesity reduces the associated complications thereby reducing the overall healthcare costs. Insurers should be jumping at the chance to help and cover the cost of obesity and weight loss drugs, but are they? Many obese people shy away from using prescription weight loss medications like Xenical because of the cost.

If you’re not lucky enough for your insurance to cover Xenical then you’ll be paying upwards of $520 for 84 tablets (GoodRX, June 2015) . Even if your insurance covers it the likely copay is still going to be in the $100’s. Weight loss drugs can be purchased online for personal importation for much less. At IsraelPharm.com 84 tablets of branded Xenical only costs $128. For many, buying online is not a choice, it’s a lifeline.

So why aren’t the insurers interested in providing coverage for these drugs? While the short term effects of weight loss are not much more than downsizing in clothing the long term benefits are enormous. Less chance of diabetes, less change of developing heart disease etc.

As far as we can see here are the top reasons why. (if you don’t agree or want to add to this list we will be happy to hear from you!)

1. The insurance companies like to see immediate results that give them a return on investment. Insurances with a high turnover of coverage will not be happy to invest in dishing out drugs for long term care as they are not going to benefit from it in the long run.

2. Some insurers still feel that weight loss drugs are more for cosmetic reasons and are misused by many who want to “get in shape for the summer”. While this perception has changed a lot over the last few years, it still remains.

3. In the past some insurers were burned when diet drugs like fenfluramine caused a lot of safety issues. While this happened years ago, it has left them weary to cover again.

4. Obesity drugs are needed for the long term, it’s not just a short course of treatment. This means that if the insurance agrees coverage, it will likely be stuck paying for it for many years to come. According to a report published in the Journal of Health Economics, obesity related illnesses already cost healthcare more than $190 billion annually. Adding more obesity drugs to the list could add even more enormous costs. Here is an interesting article on calculating the cost of obesity.

5. All the weight loss drugs on the market need to be taken alongside a healthy eating, low calorie diet and a strict exercise regime. By themselves they are not as effective. Another reason why insurance companies don’t have faith in the weight loss products. By themselves they are simply not effective enough.

The fact is that the U.S is facing and ever increasing obesity epidemic. It has to be dealt with properly and to do this investment is needed. Prevention is the best way of stopping the spread but at the same time you also need to treat the people already affected.

Investment from the government is needed to improve lifestyle education.

Investment from Medicare and healthcare insurances is needed to help obese people take back control over their weight and lifestyle. At the current drug prices it’s simply not affordable. Weight loss drugs need to be made more affordable to those who are serious about loosing weight.

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